The concept of exposome refers to the totality of the environmental exposures (diet, lifestyle, occupational and environmental factors, …) from conception onwards, including its external and internal components. Among non-communicable respiratory diseases, chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF) are two highly debilitating diseases that are of particular interest to consider in parallel in a human exposome study. The overall objective of the REMEDIA project is to determine how and to what extent the exposome affects the severity and morbidity of COPD and CF throughout the progression of disease, thus providing key elements to design more tailored prevention and care programs. We assess exposome and health data from several cohorts and population registers to determine, at various times of life, whether specific exposome(s) is(are) associated with particular phenotypes of COPD/CF in terms of severity, morbidity, exacerbations and co-morbidities. Yet, lung function development starts in utero and continue up to early adulthood, when a maximal lung function is reached. It is therefore of crucial importance to understand the impact of exposome on this key determinant of adult pulmonary health.

We hypothesize that lung diseases occurrence and lung function development during the youth is both influenced directly by individual/contextual components of the exposome and indirectly (mediated) via more complex pathways. Human research on this topic has generally focused on single exposure–health effect relationships. Our objective is to consider a broader definition to the exposome accounting for its multiple facets at the individual/contextual levels, also taking into account the potential clustering of exposures which may often be observed in combination (e.g. air pollution, socioeconomic indicators and individual health-related behaviours).

Consequently, the specific objective to be addressed using the ALPSAC cohort is to investigate whether there are specific exposome components, in isolation and/or in combination (clusters), linked to lung function trajectories and maximal achieved lung function at early adulthood, taken as an early determinant of COPD and CF outcome.